World’s smallest heart pump debuts in Southwest Florida

By Lance Shearer

The team in the NCH cardiac services unit brings a formidable arsenal of tools to bear on their patients’ behalf. In the six cardiac catheterization labs at NCH, physicians use advanced equipment including the rotoblator drill to break up rigid lesions in clogged arteries, balloons, stents, and suction catheters to remove clots. Imaging devices including the IVUS, or intra-vascular ultrasound, give doctors amazing detailed views inside a patient’s circulatory system.

Now, NCH is taking the lead once again in bringing breakthrough technology to help heart patients. The Cardiac Cath Lab at NCH’s Downtown Naples Hospital boasts the first Impella unit anywhere in Southwest Florida. No wider than a drinking straw, the Impella is the world’s smallest and most advanced heart pump.

“This represents a major commitment by the hospital to be on the frontline of cardiac technology,” said Dr. Tracey Roth, FACC, one of the surgeons on the NCH staff who is doing procedures with the new equipment. Looking at a video monitor showing recorded images of blockages inside an actual heart, he pointed to indicate the Impella, and just how small this medical marvel is in relation to what it can do.

At the end of a long narrow tube, the actual Impella pump is only a couple of inches long and no wider than a couple strands of spaghetti, yet still pumps more than five times as much blood through the heart as the devices it replaces. The older units were bulky, unreliable, and cumbersome to use, compared to the Impella, said Dr. Roth.

Many of those patients would not have been considered for coronary procedures before the Impella was available, said Steve Cooke, RN, Director of NCH’s Cardiac Catheterization Lab.

“Some patients who might have been denied therapy because they were too highrisk can now get a bypass or angioplasty,” he said. “The Impella dramatically expands our options, and allows us to treat patients who wouldn’t have been good candidates for surgery before.”

The Impella comes into play in two primary scenarios, said Dr. Roth. “We can use this in both emergency and high-risk situations. Probably in one-third of cases, it’s planned, and two-thirds unplanned,” he said. The device is a lifesaver for patients who come into the hospital with cardiogenic shock, indicating a massive heart attack, and is also literally a lifesaver for those already undergoing treatment whose hearts are weak or damaged.

Designed to be inserted directly inside the heart, the Impella device is introduced through a catheter via a small needle stick in the patient’s leg, and is considered to be minimally invasive. The physician, guided by high-tech electronic imaging, positions the Impella as needed to counteract blockages that prevent the heart from supplying blood to the body and brain.

Once within the left ventricle, the main heart chamber, the Impella can pump up to 2.5 liters of blood per minute. This is half the typical flow rate of a healthy heart, and is enough to take the strain off the heart and provide the patient an adequate supply of blood. This buys time for the cardiac surgery team to evaluate the patient, determine and perform the optimal procedure.

Cardiac Cath Lab Director Cooke emphasized the team approach to cardiac procedures at NCH.“The staff, the techs, the nurses, all embraced moving forward with the Impella program,” he said. “Everyone supported the doctors on the decision to get this.”
The Impella was developed by Abiomed, headquartered in Danvers, Massachusetts, with a European division based in Aachen, Germany. The company also created the world’s first totally artificial heart.

At NCH, the RCIS technicians, or registered cardiovascular invasive specialists, actually monitor and operate the Impella during cardiac procedures. Jeff Mays, RCIS, traveled to Boston to receive advanced training on using the device.

“Jeff now becomes what we call a ‘super user’ on this device, and he came back and shared his knowledge with the department,” said Cooke. The cardiac cath lab is, in some ways, the ‘heart’ of the cardiac program, he said. “There are about 45 staffers I direct, and we have an excellent, dedicated group.”

The NCH Downtown Naples Hospital is home to one of the most successful cardiac programs in the country. Our mortality rate is less than half of the national average, and we have been ranked among the top five percent in the nation for overall cardiac services and cardiology services for eight consecutive years. Our services include: invasive cardiac procedures, coronary artery bypass graft and cardiac valve surgeries, cardiac rehabilitation and wellness programs.